Percentage of patients with pressure ulcers/pressure injuries that are new or worsened.

The numerator is the total number of IRF stays for which the IRF-PAI indicates one or more new or worsened Stage 2-4 pressure ulcer(s) or unstageable pressure ulcers due to slough/eschar, non-removable dressing/device, or deep tissue injury at discharge, compared to admission. 1) Stage 2 (M0300B1) - (M0300B2) > 0, OR 2) Stage 3 (M0300C1) - (M0300C2) > 0, OR 3) Stage 4 (M0300D1) - (M0300D2) > 0, OR 4) Unstageable – Non-removable dressing/device (M0300E1) - (M0300E2) > 0,OR 5) Unstageable – Slough and/or eschar (M0300F1) - (M0300F2) > 0,OR 6) Unstageable – Deep tissue injury (M0300G1) - (M0300G2) > 0.

The total number of IRF stays with discharge date in the measure target period, which do not meet the exclusion criteria.

An IRF stay is excluded if: Data on new or worsened Stage 2, 3, 4, and unstageable pressure ulcers/injuries are missing at discharge: • (M0300B1 = [-] or M0300B2 = [-]) and (M0300C1 = [-] or M0300C2 = [-]) and (M0300D1= [-] or (M0300D2= [-]) and (M0300E1= [-] or M0300E2 = [-]) and (M0300F1= [-] or M0300F2 = [-]) and (M0300G1= [-] orM0300G2=[-]) The patient died during the IRF stay: • Item 44C = [0]

Data for each covariate are derived from the IRF-PAI admission assessment data included in the target IRF stays. 1. Functional Mobility Admission Performance: Coding of dependent or substantial/maximal assistance for the functional mobility item Lying to Sitting on Side of Bed at admission: a. Covariate = [1] (yes) if GG0170C = [01, 02, 07, 09, 10, 88] ([01] = Dependent, [02] =Substantial/maximal assistance, [07] = Patient refused, [09] = Not applicable, [10] = Not attempted due to environmental limitations, [88] = Not attempted due to medical condition or safety concerns) b. Covariate = [0] (no) if GG0170C = [03, 04, 05, 06, -] ([03] =Partial/moderate assistance, [04] =Supervision or touching assistance, [05] =Setup or clean-up assistance, [06] = Independent, [-] =No response available) 2. Bowel Incontinence: Bowel Continence (H0400) at admission a. Covariate = [1] (yes) if H0400 = [1, 2, 3] ([1] = Occasionally incontinent, [2] = Frequently incontinent, [3] = Always incontinent) b. Covariate = [0] (no) if H0400 = [0, 9, -] ([0] = Always continent, [9] = Not rated, [-] = Not assessed/no information) 3. Peripheral Vascular Disease / Peripheral Arterial Disease or Diabetes Mellitus: a. Covariate = [1] (yes) if any of the following are true: i. I0900 = [1] (checked) ii. I2900 = [1] (checked) b. Covariate = [0] (no) if I0900 = [0, -] AND I2900 = [0, -] ([0] = No, [-] = No response available) 4. Low body mass index (BMI), based on height (25A) and weight(26A): a. Covariate = [1] (yes) if BMI ≥ [12.0] AND ≤ [19.0] b. Covariate = [0] (no) if BMI < [12.0] OR BMI > [19.0] c. Covariate = [0] (no) if Item 25A = [0, 00, -] OR Item26A = [-] ([-] = No response available) Where: BMI = (weight * 703 / height2) = ([Item 26A] * 703) / (Item 25A2) and the resulting value is rounded to one decimal place.* *To round off the percent value to one decimal place, if the digit in the second decimal place is greater than 5, add 1 to the digit in the first decimal place; otherwise, leave the digit in the first decimal place unchanged. Drop all the digits following the digit in the first decimal place.

Effective on October 1, 2022, the IRF-PAI Version 4.0 is used to collect and submit assessment data for the IRF QRP.

Internet Quality Improvement and Evaluation System (iQIES).

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) Measures Information. Accessed August 3, 2023. Available from: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual. Accessed August 3, 2023. Available from: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient rehabilitation facilities - The Measures. Accessed August 3, 2023. Available from: data.cms.gov/provider-data/topics/inpatient-rehabilitation-facilities/measures.

Inpatient Rehabilitation Facility - Quality Reporting Program: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-

Technical specifications: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf Measures: data.cms.gov/provider-data/topics/inpatient-rehabilitation-facilities/measures

Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)